simposium iii. 1. rheumatic heart disease. dr. nahar t. spjpk

RHEUMATIC HEART

DISEASEWhat are the Consequences?

Nahar TaufiqBagian Kardiologi Kedokteran Vaskuler FK UGM

KSM Jantung RSUP DR SardjitoJogjakarta

Acute Rhematic Fever (RF) and

Rhematic heart disease (RHD)

Consequences of Haemodynamic

When to Intervention?

Consequences of Anticoagulant Therapy

An Overview

Rhematic Fever (RF) and or Rhematic

heart disease (RHD) is a a major health

hazard in most developing countries as well

as sporadically in developed economies

Rheumatic Heart Disease

RF and RHD are systemic inflamatory

disease with protean manifestation

primarily affecting the connective tissue

and usually preceded by a group A beta

hemolytic streptococcal (GABHS)

infection characterized by acute

exacerbation and recurrencces


Infection by GABHS

2 – 5 days intubation

URI infectionhigh fever, sore throat, headache, body weakness,

and increase in WBC count

Acute Rheumatic Fever

Acute Rheumatic Heart Disease

3% of them develop RF after

Several weeks

Major : Carditis, Polyarthritis,Chorea,

erythema marginatum, Subcutaneus nodule

Minor : Clinis : arthralgia , fever

Lab : Erythrocyt cedimen rate, C – reactive protein

prolonged PR interval,positive throat culture,etc

2 Major or 1 major 2 minor

Evidence for recent GAS infection

Acute Rheumatic heart disease

Divided into rheumatic endocarditis,

rheumatic myocarditis

and rheumatic pericarditis,

often for rheumatic pancarditis.

Management ARF-ARHD

1. Eradicate the GAS

Benzathine Penicilin G ,

< 27 kg : 600.000 U –IM (once)

> 27 kg : 1,200,000 U – IM (once)

Erythromycin estolate, 20-40mg/kg/2-4 times daily ( 10

days)

Erythromycin Ethylsuccinate 40mg/kg/2-4 times (max 1

g/d) (10 days)

Management ARF-ARHD

2. Suppress the Inflamatory response

Aspirin 90-120 mg/kg/day for 10 weeks and tapered in the

next 2 weeks

> 20 kg: Prednison 60 mg/day three weeks and tapered in

the next nine weeks

< 20 kg : prednison 40 md/day

Secondary Prevention of RF

• Benzathine Penicilin G 1,200,000/ 3-4 weeks – IM

• Penicilin V 25 mg twice daily – oral

• Erythromycin 250 mg twice daily -oral



Acute rheumatic endocarditis: small (diameter 1- to 2-mm)

vegetations along the mitral valve margin, insufficient to

cause valvular deformation.

Chronic Rheumatic Heart Disease

Mitral Regurgitation

Mitral Regurgitation

Porcine model, 6M

Mitral Stenosis

Due to the vibration of the anterior leaflet of the mitral

valve as it is buffetted simultaneously by the blood jets

from the left atrium and the aorta.

Aortic Regurgitation

Aortic Regurg – Austin Flint Murmur

Aortic Regurgitation

Aortic Stenotic

TERIMA

KASIH

Dr. T Duckett Jones

- Major Manifestation

- Carditis, Arthritis, subcutaneous nodules,

erythema marginatum and chorea

- Minor manifestation

- Fever, arthralgia

- Essensial Criteria



Acute rheumatic endocarditis: small (diameter 1- to 2-mm) vegetations along the mitral valve

margin, insufficient to cause valvular deformation.

Small vegetations (verruca) are visible along the line

of closure of the mitral valve leaflet (arrows).

Advanced: vegetations organization, recurrent organization cause chronic heart valve disease (

valvular stenosis and / or valvular insufficiency )

Mitral stenosis with diffuse fibrous thickening and distortion of

the valve leaflets, commissural fusion (arrows), and thickening

and shortening of the chordae tendineae.

Rhematic Fever (RF) and or Rhematic

heart disease (RHD) is a systemic

inflamatory disease with protean

manifestation primarily affecting the

connective tissue and usually preceded

by a group A beta hemolytic streptococcal

(GABHS) infection characterized by acute

exacerbation and recurrencces


Template Jogja Cardiology Update

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Jogja Cardiology

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simposium iii. 1. rheumatic heart disease. dr. nahar t. spjpk

Health & Medicine